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The impact of comorbidity burden on the cardiovascular risk in the Peripheral Arteriopathy and Cardiovascular Events

G Brevetti1, G Giugliano, G Oliva

  • 1Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples 'Federico II', Naples, Italy. brevetti@unina.it

QJM : Monthly Journal of the Association of Physicians
|May 9, 2008
PubMed

Insights

Evaluating overall comorbidity using the Cumulative Illness Rating Scale (CIRS) is crucial for predicting cardiovascular events like myocardial infarction and stroke in peripheral arterial disease (PAD) patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Epidemiology

Background:

  • Comorbidity significantly impacts chronic disease outcomes due to competing risks.
  • Accurate comorbidity assessment is vital for predicting patient prognosis.

Purpose of the Study:

  • To evaluate the prognostic value of the Cumulative Illness Rating Scale (CIRS) for cardiovascular risk in the Peripheral Arteriopathy and Cardiovascular Events (PACE) study.
  • To assess the association between CIRS scores and cardiovascular events in patients with and without peripheral arterial disease (PAD).

Main Methods:

  • Prospective study design.
  • Inclusion of 60 peripheral arterial disease (PAD) patients and 163 non-PAD subjects.
  • Calculation of Cumulative Illness Rating Scale-illness severity (CIRS-IS) and CIRS-comorbidity index (CIRS-CI) scores.

Main Results:

  • Higher CIRS-IS and CIRS-CI scores were associated with increased risk of myocardial infarction or stroke in the overall cohort.
  • This association disappeared when 'concordant' conditions were excluded, except in PAD patients.
  • In PAD patients, CIRS-IS and CIRS-CI scores, excluding 'concordant' conditions, significantly predicted cardiovascular risk (RR=4.03 and RR=1.43, respectively).
  • CIRS scores enhanced the predictive value of the ankle-brachial index in PAD patients.

Conclusions:

  • Overall comorbidity, not solely cardiovascular comorbidity, is essential for predicting myocardial infarction and stroke in PAD.
  • The CIRS tool, particularly when excluding 'concordant' conditions, offers valuable prognostic information for PAD patients.
  • These findings underscore the importance of comprehensive comorbidity assessment in vascular disease management.
Abstract

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